[toggle title=”UNDERSTANDING HOSPITAL BILLING”]
The following information is relevant as per MooiMed Private Hospital protocol, as well as the rules and regulations of your medical scheme:
Hospital billing only covers the hospitalization itself. The following services are excluded from the MooiMed Private Hospital account, and will be billed separately by these institutions and service providers:
- Doctors, Anesthetists and Assistant Doctors
- Pathology / Laboratories
- Dietitians, Speech- and Occupational Therapists
[toggle title=”CO-PAYMENTS & LEVIES AND DEDUCTIBLES”]
- It is the responsibility of the member to be aware of any co-payments, levies and deductibles applied to certain procedures [as per scheme and plan type] which will be your responsibility to settle on or before the day of admission.
- Please check with your medical aid that MooiMed Private Hospital is regarded as a service provider to your medical aid – specifically the relevant plan on which the membership is based.
- Ensure that authorization was granted in full – you will be held liable for the co-payment/levy/deductible indicated by your scheme for full settlement upon admission.
It is your responsibility to:
- Ensure you are a valid member of a medical aid scheme, if applicable, and that your monthly premiums are up to date. Pro-rata benefits may be applicable in case of new membership.
- Disclose all waiting periods enforced by your scheme to your doctor and the hospital.
[toggle title=”BENEFITS AND LIMITS”]
- It is the responsibility of the member to be aware of their individual benefits available, as well as limits applied to their membership. This information is deemed confidential by some of the medical aids and will not be disclosed to hospitals upon pre-authorization.
- Ensure you have sufficient benefits available for your procedure – this includes internal/external prosthesis, appliances, physiotherapy, TTO medication prescribed, etc.
- Obtain an estimated quote from your surgeon for prosthesis items used during your procedure.
- Ensure that you have enough available limits to cover these items.
- If insufficient limits are available, the member will be held liable to cover the shortfall upon admission.
- In the event that more prosthesis items are used by your surgeon during your procedure than originally quoted, the member will be liable for any shortfall due to depleted benefits.
[toggle title=”SUBMISSION OF HOSPITAL ACCOUNT TO SCHEMES”]
All medical scheme, as well as private accounts will remain the responsibility of the member. MooiMed Hospital will submit the account on behalf of the member to their relevant scheme. The member must ensure that the account was received by the medical scheme within 30 days after discharge date and will remain the responsibility of the member to follow up until settled in full by the medical scheme. Should the medical scheme fail to pay the account in full, the member will be liable for the balance and payment in full to MooiMed Private Hospital within 30 days.
- Credit refunds available to members will be reimbursed to the main member during scheduled payment runs every fortnight. Refunds will only be made once acceptable proof of bank account was received:
- Official letter from your bank, cancelled cheque or top stub of bank statement reflecting only the name of the account holder and bank account details.